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Delivery: The real deal and stuff no one tells you about

©MFMER

Learn why Rachel’s delivery room scene on “Friends” qualifies as “the most unrealistic birth ever.” Myra J. Wick, M.D., Ph.D., Mayo Clinic obstetrician, gynecologist and medical geneticist, joins co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D. to guide you through the reality of labor (vaginal or C section), including:

*          Why you should expect to get an IV

*          Why your birth team may include up to 10 people in scrubs

*          Whether it’s okay to eat and drink during labor

*          Why things get messy (vomiting, pooping) and that’s actually fine

*          How you can prepare for effective pushing

*          What to do to prevent vaginal tearing

Listen: Delivery: The real deal and stuff no one tells you about. 

Read the transcript:

Dr. Angela Mattke:

Welcome to the “Mayo Clinic Moms” podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor also at Mayo Clinic and is also pregnant.

On our last episode, we talked about preparing for delivery, and on today’s episode, we’re getting into the nitty-gritty details about what delivery is actually like. Will it be a vaginal delivery, or will you end up with a C-section, and is a C-section really that big of a deal? Is it like on TV or a sitcom or a movie when everything is calm, and no one’s stressed and there’s no chaos, and you look camera ready because your glam team did your hair and your makeup? And then you push for three minutes and the baby comes out, and they look six months old, and there’s no blood on them whatsoever? That is not reality. On today’s episode, we’re going to tell you what it’s really like. Nipunie, I don’t mean to scare you, but we are going to get into some reality-based conversations. I don’t mean reality TV-based, but seriously, like, TV, video, movies, sitcoms–they all get it wrong. When I was prepping for this episode, I watched the Friends birthing episode. Do you remember watching the Friends episode when Rachel gives birth?

Dr. Nipunie Rajapakse:

Yes, I do.

Dr. Angela Mattke:

I think it wins the award for the most unrealistic birth ever. She pushed for one minute and 38 seconds. I actually counted. Do you guys have a favorite birth video, movie, sitcom or episode?

Dr. Nipunie Rajapakse:

So not to rag on Friends, but they have triplets at some point during the series as well. And that is a very smooth vaginal delivery of triplets at full term, it looks like, who also come out looking pristine. I have to say since I got pregnant, it seems like my Instagram feed is all about babies and pregnancies and lots of pictures of people with their hair done perfectly, full face of makeup, and something tells me that’s not how my postnatal pictures are going to look.

Dr. Angela Mattke:

Yeah, there’s no such thing as perfect. Life isn’t perfect, and delivery is definitely not perfect. It’s pretty messy. And our fabulous guest Dr. Myra Wick, who is an obstetrician-gynecologist and medical geneticist at Mayo Clinic, is going to be able to tell us all about that. Not only is she an obstetrician gynecologist, but she is also the medical editor of Mayo Clinic Guide to a Healthy Pregnancy. Dr. Wick, thanks for joining us back again today and to hopefully give us a realistic view about what delivery is actually like.

Dr. Myra Wick:

It’ll be fun and interesting.

Dr. Angela Mattke:

Yeah, it will be; I mean, this is your everyday life, but for us it’s more of a not-very-often experience. I have to tell the audience and Nipunie this story. You probably don’t remember it because this was just every day for you, but back when I was a resident–oh, this was probably 12 years ago– I remember you in this delivery, and it was an alpha C-section and the baby was stuck in the pelvis and not coming out, and was having distress. We went to this emergency C-section and you were just so calm, cool, collected. It was a really difficult extraction. And I still remember that moment–you were just in command of the situation; the baby was fine, everything was calm. Even though it was a really, really stressful experience, I think, for you and probably everyone else in the room, too. I don’t know, how do you do it? How do you stay so calm and collected during deliveries?

Dr. Myra Wick:

Well, we’re not always calm inside. Blood pressure goes up, heart rate goes up, lots of adrenaline. But yeah, there can be very stressful situations, and sometimes we may not be as calm as we look.

Dr. Angela Mattke:

Yeah. Well, you certainly fooled me. Your leadership was just on point in that moment. I’ll never forget it. And it was such a beautiful moment because everyone did so well. Anyway, let’s get into the details of talking about what a vaginal delivery is really like. Let’s start with like the timeline, Dr. Wick. When should Nipunie go into the hospital?

Dr. Myra Wick:

Well, usually we tell patients if they’re contracting every three to five minutes, contractions are getting stronger. And if it’s actual labor, usually you’re having to stop and breathe through the top of that contraction. Those are some of the things that we use. If your water breaks, we want you to come in pretty much right away, even if you’re not contracting, because at that point, your risk for infection after several hours, it will start to increase. We want to know when your water breaks, and we would encourage you to come in. Similarly with bleeding–in early labor, you can have some spotting and discharge, and you can have pinkish-tinged spotting, and that’s all normal. But if you’re having actual bleeding, then we want you to come in as well.

Dr. Nipunie Rajapakse:

Dr. Wick, can you give me just a sense of what to expect in the room? Say I’ve gone in, I’m in labor, I’m in the labor room. What might I expect to see in there? Will I be hooked up to things? Who might be coming in and out at that point?

Dr. Myra Wick:

Can I back up to triage for just one second?

Dr. Angela Mattke:

Good call.

Dr. Myra Wick:

A lot of labor and delivery areas or family birth units will have a triage area where they assess patients to make sure they’re in labor. We want to make sure you’re in labor before we admit you. And so sometimes people get sent home. They’ll have their cervix checked, and maybe it’s two centimeters or three centimeters, and rechecked two hours later. It hasn’t changed even though they’re contracting and uncomfortable, and you might get–if everything looks good, your cervix hasn’t changed — you might get sent home.

Dr. Angela Mattke:

Unless you’re like me, and you don’t go home, and you’re like, “Nah, I’m going to stay. Can we just get this going?”.

Dr. Myra Wick:

But it’s okay. It’s okay if that happens. People sometimes are like, “Oh, they’re going to send me home,” but it’s fine. It’s okay to get sent home and come back. But once you’re admitted in our facility, the OB team will come in and meet you. The anesthesia team comes in to meet you. Initially, we do want to get a fetal heart rate tracing on the baby, and we want to be monitoring your contractions. But once things are stabilized, and we know that you’re okay, we might let you walk around the room, and we might let you be unmonitored for short periods of time. If everything is looking good, we do like to get an IV in most patients.

Usually, you can anticipate that you’re going to have an IV if you’re in a hospital. And sometimes people ask, “Well, why do I need to have an IV?”. If we have some emergency where we need to give you blood, or we need to give you a medication, then we have that access right away. We don’t have to wait to get that IV placed before we can do what we need to do. And then in our facility, there’s a nurse that stays with you almost the entire time unless you’re sleeping. There’ll be somebody in your room a lot of the time. We do rounds a couple of times a day. Sometimes we have a big group in labor and delivery. We have a couple of staff. We have a midwife, we have residents, we have other learners. Sometimes you’ll have maybe 8–10 people come into the room and introduce themselves as the team on call. Sometimes that’s overwhelming for people, too, to have to see all the staff that’s coming in and introducing themselves. Did I answer your question? Did you have more to ask?

Dr. Nipunie Rajapakse:

Yeah, no, that’s fantastic. I know it’s possible to be in labor for many hours and that can be quite strenuous. What about eating and drinking? Is that something that is allowed in labor?

Dr. Myra Wick:

Yeah, we allow patients to eat and drink and unless they’re having a planned C-section–then, we want patients to be fasting for our anesthesia team. But for vaginal delivery, patients can eat and drink throughout labor. It’s not all that uncommon to throw up when you’re in labor. I know I did, and that’s not very fun, but we don’t restrict what people are eating and drinking if we’re planning for a vaginal delivery.

Dr. Nipunie Rajapakse:

When it comes to pushing, I’ve heard a lot of different things. How do you know or do you know, if you’re pushing properly or not? Or do you have any tips for that part of things?

Dr. Myra Wick:

Yeah. One thing that people don’t like to hear is when you push, it’s like you’re pooping, and a lot of patients do poop and they think that that’s horrible. But your OB team, your delivery team, they actually think that’s fine because that tells us that you’re pushing the right way. That’s one of the things that we use. We also look to see if the baby’s making progress down the vaginal canal; that also tells us that mom’s pushing correctly. Sometimes it’s hard to know if you’ve never done it before.

Dr. Nipunie Rajapakse:

Exactly.

Dr. Angela Mattke:

It seems like there’s like a learning curve with it. Does it seem like every (what we call) prime or first-time mom has a learning curve during the phase two of labor when they’re doing the actual pushing?

Dr. Myra Wick:

Definitely. Yeah, we don’t expect on the first couple pushes that we’re going to see the baby coming way down, descending into the vaginal canal. Sometimes you’ll have several people in the room coaching, and sometimes it’s helpful, and sometimes it’s not, to have three or four or five people telling you “PUSH!”.

Dr. Angela Mattke:

Yes.

Dr. Myra Wick:

And I think at that point, the patient should voice: “Please just have one person telling me what to do,” or if there’s a person who seems to be most helpful, sometimes it’s your partner.

Dr. Nipunie Rajapakse:

I have to admit one of the things that probably worries me the most about delivery is ending up with a tear. I’ve heard a lot of stories, obviously seen some during my OB rotation and training as well. Is there anything that I can do in advance, even before you’re in labor, to prevent tearing or anything during labor itself, that you can do to prevent that from happening?

Dr. Myra Wick:

Yeah. Some people will use perineal massage during the end of pregnancy. It’s a massage technique on the perineum or on your bottom. And some people think that that helps to prepare and maybe help to prevent some tearing. Tearing is really common in first-time moms and having what we call a second-degree tear, which is a tear that goes a little bit into the muscle between the vagina and the rectum– not all the way through, just a little tear– that’s very, very common. We’re very adept at repairing those and getting things back together. To not tear during — for a first-time, mom, if it’s an average size baby –that’s pretty unusual, I’d say. Also listening to the provider during, or the person who’s doing the delivery, while you’re delivering, they’ll try to — if the baby’s heart rate tracing looks good — they’ll try to slow a little bit that very last part where you’re pushing the baby’s head out.

That’s when most of the tears occur, if the baby’s head comes out really quickly. They’ll try to massage that part of the delivery, if you will, and have you try to be controlled during that part. That helps to prevent some tearing as well. Does that help?

Dr. Nipunie Rajapakse:

Yeah. I think it’s good to know. Actually, I was a bit surprised to hear that it’s probably more common to tear than not because I thought it was the exception rather than rules. I think going in with realistic expectations often can help some of these things not be as so scary when they happen to you.

Dr. Myra Wick:

Yeah. And the nurses are really good after you deliver about telling you how to take care, and sitz baths and those kinds of things. Maybe we’ll get to that.

Dr. Nipunie Rajapakse:

Similar to tearing and when the baby comes through, sometimes you have to intentionally increase the opening or something called an episiotomy. Maybe can you explain what that is? And then, Angie, maybe you can share some of your experience as well.

Dr. Angela Mattke:

I’d love to.

Dr. Myra Wick:

Yeah. An episiotomy is a cut that we make. And there are different types of episiotomies. Where I train, we do what’s called a right mediolateral, which means we cut a little bit off to the patient’s right side from the—[demonstrating] if this is a vagina, I know we cut this way. And that helps us to avoid getting into the rectum, which you don’t want to do. But it gives you more space, if you will. We don’t do that routinely. The American College of Obstetrics and Gynecologists does not recommend that we do that routinely. But we do it in a situation where if it looks like the mom is going to have a big tear; it’s a lot easier to fix a surgical cut than a big tear that’s everywhere, what we call a stellate tear. That would be one situation, or if the baby’s almost crowning, and the heart rate is really low, and we’re worried about the baby. We might cut an a episiotomy to facilitate a faster delivery. Then the other time when we would routinely cut an episiotomy is if we’re doing an operative vaginal delivery of forceps or a vacuum delivery; those usually happen a little bit more quickly than if you were pushing naturally. We want to give ourselves enough room so that we don’t have a really big tear or a tear into the rectum, which can be a lot more difficult to repair, and the recovery can be more difficult.

Dr. Angela Mattke:

I have a couple of things to add. I was chuckling to myself as you were talking about trying to have more of a controlled last part, because it made me think of a really controlled and peaceful delivery–but most deliveries, and I think everyone needs to prepare themselves for this, are chaos, no matter how calm, cool, collected everyone is in the room. There’s still a degree of chaos. I think no one is really prepared for that. There are lots of people in the room; there’s grabbing; there’s yelling–even in the best situations. And in my situations like I’ve alluded to before, my boys were very naughty; their heart rates were naughty; they had Category II tracings.

They had late deceleration; their heart rates weren’t good. I was on oxygen for 10 hours. And so, because my kids weren’t doing very well, and like I had alluded to in our last episode, my birth plan was a healthy baby, that they had to do an emergency episiotomy on my first one, plus a tear, just to get the baby out because his heart rate wasn’t doing well. And it turns out, I think he had a nuchal cord at least once, maybe more, but he did great. The best thing about it as a pediatrician is I wanted to know what his cord gas was, and it was perfect. That means we look at the pH of the baby to see how their oxygen was during delivery and stuff. It turned out okay. Wasn’t what I wanted, no, but I wanted a healthy baby, and that’s what it took to get my baby out quickly enough to make sure that his heart rate was good, and his oxygen supply wasn’t diminished during delivery because babies need oxygen for their brains. It’s really important for them. Just keep in mind, all the listeners out there, it’s going to be a little bit chaotic. You’re going to feel the surreal experience with so much going on around you, and all you’re supposed to be focusing on is pushing. It’s not like it is in the sitcoms, people. It’s not going to be like a Rachel delivery, and you cough, and the baby comes out.

Dr. Myra Wick:

Right. And sometimes during the first stage of labor, when you’re dilating, sometimes we have to do some interventions then, too, that people might not be aware of. Sometimes we’ll have a monitor inside to monitor the strength of contractions. Sometimes we’ll put a little teeny electrode on the baby’s head so that we get a better heart rate tracing. Lots of different things can happen that patients might not be prepared for. Angie mentioned oxygen. I remember having oxygen with my vaginal deliveries.

Dr. Angela Mattke:

Yep. All my pictures I have of me with this beautiful oxygen mask on and stuff. You can’t really see my face and everything, but you’ll do anything for your babies. You just do what you need to do to get your baby out, but sometimes like you said, it doesn’t go as expected and if the vaginal delivery isn’t going well, then your role as an obstetrician is to start to think about–do we need to think about something different? Do we need to be thinking about a C-section? Is this vaginal delivery not in the best interest of the mom and baby? Can you tell us a little bit more about those situations and how they might come up?

Dr. Myra Wick:

Yeah, so there are certain situations where we would plan for a C-section. One would be if the placenta is low-lying or if the placenta is over the cervix. We can’t labor that situation because there would be a lot of bleeding, and that could be very dangerous. We won’t let patients plan for vaginal delivery if the baby’s breech, because that could also be a dangerous situation.

Dr. Angela Mattke:

Another reason why the Rachel episode was false–it was a breech delivery, by the way. Sorry, Dr. Wick–and they proceeded with a full breech delivery, and it was a minute and 30 seconds.

Dr. Myra Wick:

Yeah. We wouldn’t let that happen. Does it ever happen? Yes, but not planned. Sometimes when you’re in labor, things happen that cause us to run back and do an emergency C-section. I had mentioned with my third baby, I had an abruption, which means the placenta shears off from the side of the uterine wall, and then the baby isn’t getting nutrients and oxygen from the mom. And that’s an emergent situation often. That would be a situation. Sometimes the mom has a heart rate tracing. Angie mentioned her baby’s heart rate tracings were concerning, and after a period of time, it depends on the situation and what we’re seeing, but sometimes that heart rate tracing is concerning enough that we’re worried about the baby’s health, and whether it’s getting enough oxygen. If the mom isn’t close to delivery at that time, then we might have to move towards a C-section. If the mom’s been pushing for a really long time, we really don’t like to see moms pushing for up to four hours, especially if they’re not making any progress. And maybe the baby’s too big or not going to fit through the pelvis; maybe the baby’s position isn’t quite right for coming through the pelvis. That would be another time when we might move towards a C-section.

INTERMISSION

Dr. Angela Mattke:

Are you thinking about getting pregnant, or maybe you’re a current mom-to-be, or you’re like myself and you’re in the midst of raising kids, and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press wherever books are sold, or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Angela Mattke:

Speaking of C-sections, I think there sometimes may be a perception that this isn’t really that big of a deal. And it just seems “an easier” alternative to a vaginal delivery, because you don’t get all that carnage to the vaginal area that happens after a vaginal delivery. And I say that chuckling, but also serious. I’ve seen C-sections; you obviously perform C-sections; we know they’re a big deal. Can we talk a little bit more in detail about what really happens with the C-section? And why is it not just a walk in the park, and then you go home and everything’s fine?

Dr. Myra Wick:

Yeah, so it’s a major abdominal surgery. Your abdomen’s open, so it is a big deal, and the recovery is more than after vaginal delivery, usually. We don’t want you lifting more than 20 to 25 pounds. Sometimes, especially if you have a toddler at home, that can be really, really tough for a mom to come home and not be able to lift the toddler. With any surgical risk, we worry about bleeding. We worry about getting into other structures; the bladder and the bowel are right there. And every once in a while, especially if it’s an emergency situation, we might get into a situation where we nick the bowel or the bladder, and then we have to ask colleagues to come in and help. Sometimes patients need transfusions; so it can be a big deal.

Dr. Angela Mattke:

So Nipunie, I know that you had said on our last episode that you guys are still evaluating about whether you might need a cesarean section. Do you have any specific questions for Dr. Wick about what to expect if you do need one?

Dr. Nipunie Rajapakse:

Yeah, so I guess one of my questions–obviously being pediatricians, we know the importance of skin-to-skin for the baby after they’re born. Is that something that I’ll be able to do if I end up having a C-section, or because of the sterile field and all of the other things that are going on in an operating room, is that not possible?

Dr. Myra Wick:

Yeah, we work really hard to try to make that happen. I think of the operating room in three sections– and Angie, you can jump in on this one too–but there’s the patient’s head and arms and where the anesthesia team is located. And that part is behind this sterile drape. Then we usually put a drape right about here on the chest level; then the middle part of the room is where the obstetrics team is doing the C-section and the delivery. At the opposite end of the room, towards the mom’s feet, is where the pediatrics team is hanging out and waiting for the baby. Then we’ll take the baby for the initial assessment. We always try to hold the baby up over the drapes so that the mom and dad can see the baby right away, or we put the drape down so the dad can take pictures.

Dr. Angela Mattke:

I call that the Simba moment.

Dr. Nipunie Rajapakse:

Yeah! The Simba moment!

Dr. Angela Mattke:

When they present the baby, it’s like from The Lion King.

Dr. Myra Wick:

Yes! And sometimes we’ll have couples that don’t know the gender of the baby, and the dad wants to announce the gender, so that’s something we can do. Then the baby goes to the pediatrics team, and the pediatrics team does their first assessment and usually does a little bit of cleaning up. If everything’s going well for both the mom and baby, one of the pediatric nurses will bring the baby around, up by the mom’s head and try to get nursing started, get the baby right up by the mom’s arm and face. We try to have that skin-to-skin experience, if we can, in the operating room. And then the mom has to leave holding the baby in the operating room.

Dr. Angela Mattke:

That’s awesome.

Dr. Nipunie Rajapakse:

Great. How do things maybe go differently when it comes to things like initiating breastfeeding? Do you see major differences between people who have had a vaginal delivery versus a C-section or different challenges related to how the baby’s doing?

Dr. Myra Wick:

Usually, things go pretty well. I think from my own personal experience, I felt like I had to hold the baby a little bit differently than I had with the first two just because of the incision. But we have great lactation consultants and nurses that will help you with positioning the baby. Take advantage of that when you’re in the hospital–if there’s lactation consultants, or a lot of the nurses have special training in assisting with lactation, so tap into them as a resource.

Dr. Nipunie Rajapakse:

Awesome. And then when it comes to recovery, so I’ve heard–and maybe you can tell me if this is true or rumor–the first day usually isn’t too bad, but it’s the second day that people really seem to get hit hard. Have you noticed that in your experience, or does it seem to vary quite a bit?

Dr. Myra Wick:

It varies, but I think there’s probably some truth to that, where you’ve got that high from the first day; the baby’s here, you’re super excited. Maybe even get out of bed a couple times. And then that second day, maybe you didn’t sleep the night before, and you’ve been trying to nurse all night and you’re having a little bit more incisional pain when you get in and out of bed. We try to keep you super comfortable, though. We have patients primarily taking ibuprofen and Tylenol. We might give you a little bit of narcotic pain medication. We tend to use oxycodone, but we’re really careful about that because we don’t want to cause any problems with dependence or addiction. Patients do amazingly well with Tylenol and ibuprofen. For a lot of patients, it really controls the pain quite well. We keep you on a schedule so that you don’t get off the schedule and all of a sudden have a huge, “Oh my goodness, I haven’t had anything for hours. And now I’m in a lot of pain”.

Dr. Angela Mattke:

I feel like that’s one thing a partner can really help with, is making that schedule, even when you leave the hospital. Because then in the hospital, the nurses are going to do a fabulous job maintaining your pain control. But when you get home, and you’re busy, and you’re tired, and now you have this baby all by yourself, your partner can really help with setting timers and making sure that even if you don’t have pain in that moment, giving you the pain medication so that you don’t fall behind–especially in those first couple days when you get home. I know my husband was really helpful with that, and it helps them feel like they’re doing something, and they’re part of this recovery process.

Dr. Nipunie Rajapakse:

Yeah, that’s a great tip, Angie. I’ve been thinking about it a lot because my partner, Thomas, he’s not in the medical field at all. I know it’s going to be an overwhelming experience for him, just the birth of a child, obviously, but all the other medical stuff that goes along with it. I’ve been trying to think of ways that he can be involved and feel like he’s part of what’s going on as well, because it’ll be a very unfamiliar environment for him also. So that’s a great idea. When it comes to post-delivery stay, I know there’s some variation. Angie, I don’t know how long you were in hospital after your little ones were born, but how does the length of time you spend in hospital after delivery vary between a vaginal delivery and a C-section?

Dr. Myra Wick:

Yeah, well in in the pre-COVID era, we would usually have moms who had vaginal deliveries stay for two nights and C-sections for three nights. And then sort of at the peaks of COVID, we tried to cut that back to one night for vaginal delivery or at least 24 hours, and then two nights for a C-section with a low threshold to keep moms. If there were any complications–definitely going to keep you 24 hours. We want to make sure, and you as pediatricians can add your comments here, too, but we want to make sure that both the mom and baby are ready to go, and we’ve done all the appropriate screening for the baby.

Dr. Angela Mattke:

I love that you brought up the screening for the baby. I want to get into that in a moment. I think I was ahead of my time because I broke out of the hospital early before the COVID pandemic. I think some people really enjoy being in the hospital and it’s helpful. I was not one of those people. I could never sleep in a hospital. I asked to leave early but not before 24 hours of life because I feel very, very, very strongly about making sure all of my newborn screening was performed on my infant, which we can’t do before 24 hours of life. And we’ll get into that in a little bit more. But yeah, I wanted to get home and then just have a really close follow-up with my providers to make sure that everything is going well because those first couple days when you get home are really stressful.

Dr. Myra Wick:

Yeah. The hospital can be a tough place to sleep. You’ve got people coming in and checking on you, and it’s noisy sometimes. Sometimes it’s better to be home.

Dr. Angela Mattke:

Yeah, exactly. Speaking about people, there’s always someone coming in, whether it’s nursing or housekeeping or food delivery and other things. One of the things that nursing is really instrumental in is making sure that infants get the really important “after newborn” stuff. In that first day, there are going to be a couple things that we strongly recommend that all infants have, which is vitamin K, hepatitis B vaccine, and then erythromycin eye ointment. And we can talk about those in a little bit more detail in a second, but then after 24 hours of life, it’s really important that all infants get newborn screening. Maybe you’ve heard of them as the blood spot testing, and every state in the United States determines what type of genetic diseases that they test for. Dr. Wick, you can correct me if I’m wrong, but I think Minnesota is up to 61 different conditions that we do screen for. Is that correct?

Dr. Myra Wick:

Yeah, I think that’s right. I sometimes lose track, but that sounds right.

Dr. Angela Mattke:

We keep adding more and more, which is really, really exciting for us because we’re only screening for things that would affect the baby’s outcomes, and that we typically can intervene on and really help affect their life trajectory outcomes and their health. Is that a good assessment?

Dr. Myra Wick:

Yeah. That’s the goal of the newborn screening. As you know, there’s some controversy; there are a few things on there that that could be potentially life-threatening that we aren’t able to treat, but at least we can prepare. There are many disorders that we screen for, where if we change diet or know what’s going on, we can prevent catastrophic outcomes.

Dr. Angela Mattke:

Speaking of catastrophic outcomes, let’s go back to the vitamin K, which is an injection. We give it to all infants after birth because they do not have very good levels of vitamin K, and there are a couple different reasons for it. Our liver and our intestines actually produce vitamin K, and it’s actually really low after birth, but it’s an essential vitamin for blood clotting. Because there’s this lag time before our body starts producing it, there’s this critical window where if infants don’t have high enough vitamin K levels, they could have catastrophic or life-ending bleeding, such as hemorrhages in their brain or their intestines or other areas. We do a very, very safe injection of vitamin K to boost them until their body’s able to make it, and until they also get a little bit in the breast milk as well.

But I remember specifically asking my nurse for it. I was like, “Hey, did you give him the vitamin K yet?”. They’re like, “Oh, I thought you wanted to spend some more time with him”. I’m like, “Nope, come on over. Put some shots in my baby; let’s make sure that they’re safe, and then I’ll go back to breastfeeding”. So, I think, don’t be afraid to ask for it, and then they can also do the hepatitis B vaccine right at that time. Any questions about other newborn screening processes that we go through, Nipunie? Or do you feel like you have a good handle on those?

Dr. Nipunie Rajapakse:

I think it would be helpful to review them. It’s been a while since I was in a normal newborn delivery situation.

Dr. Angela Mattke:

Right, since you are a specialist in infectious disease. Well, one of the other things we do is we screen for critical congenital heart disease. These are the heart lesions that are really dependent on the baby’s physiology before they’re born. After the baby’s born, there’s something called a PDA that closes, and it can make it really hard, really life-threatening for an infant to be able to oxygenate their blood after that PDA closes. By simply checking their oxygen saturations–it’s a completely non-invasive test–we put a little sticker on your baby’s hand and their foot, and then we check their oxygen saturations to make sure that everything is good. We’ll look for big differences between the two. If there’s a big difference, then we do an ultrasound of your baby’s heart to help us figure out if there’s anything that’s actually going on in their heart that we could potentially prevent things from getting worse.

We can keep that PDA open until they would potentially need heart surgery instead of us getting into a really scary situation where your baby’s oxygen’s falling very, very quickly. There’s another one that’s super simple. We just do a hearing test. If we can catch hearing loss very early in life, we can potentially affect your child’s developmental outcomes for their speech and language if we identify them early. Then there’s one other thing we do, and this is checking for your baby’s bilirubin. Bilirubin is jaundice or   the yellowing of your baby’s skin. In most places across the United States, we’ll start with simply scanning your baby’s skin. It’s called a transcutaneous bilirubin level, and it’s a really good screening test, but it’s not a really good diagnostic test to say exactly what your baby’s bilirubin is.

If it’s elevated, we’ll need to get a blood sample to look at your baby’s bilirubin. Now all babies after birth are going to have some degree of jaundice, and that is completely normal. The type of jaundice we worry about is when the bilirubin gets too high of a level because that can affect your baby’s brain, especially in the first couple days of life where this barrier called the blood brain barrier is a little bit more permeable, meaning the bilirubin can go through it. If bilirubin can go through it and get to your brain, it can cause catastrophic damage to your child’s brain — lifelong — going forward. That’s the really scary part. Most babies never get to that because it’s recommended that all babies get universal bilirubin screening. We can just be a little bit more proactive if your baby’s bilirubin is getting higher and do things to help bring it down. That would be maybe improving feeding or in some situations, we might need to add some of what we call blue light or bilirubin lights, to help bring the bilirubin down because it helps with how it’s excreted when we do a little light therapy. Does that ring any bells for you, Nipunie? I’m sure you know that stuff pretty well.

Dr. Nipunie Rajapakse:

It sounds familiar, but always good to have a reminder of those.

Dr. Angela Mattke:

Yes, exactly. Dr. Wick, let’s move on to talking about some breastfeeding questions and concerns. Nipunie, are you planning on breastfeeding, or are you still figuring that out? Or are you going to just see how things go?

Dr. Nipunie Rajapakse:

We’re planning to. I’ve heard a lot of different experiences from different people, and that it’s maybe not always as easy as it is made out to be in some situations. It might take a while for me and for the baby to learn how to do it, but that is our plan. We’re open to other options if things are not going well.

Dr. Angela Mattke:

I would recommend that you look into breastfeeding resources before you breastfeed, because everyone thinks it’s super natural. The baby’s just going to go on your breast and latch right on. But having some knowledge before you do it is really powerful, and there are so many resources. There are classes that you can take, probably more-so online now. But in person, there are incredible resources actually through WIC, which is a national program called Women, Infant, and Children. And they have incredible lactation support. Dr. Wick mentioned in the hospital that there are usually really helpful nurses with special certifications in lactation that can help you in the hospital. There are two different certification levels. There’s one called a CLC and one called IBCLC.

And they’re incredibly helpful. There are also opportunities probably with your local health clinic or your hospital to have drop-in lactation support after you leave the hospital, so you’re not alone. There’s also something called baby cafés, which is a national organization where you can drop in and have peer breastfeeding support because I think we all have a lot of different knowledge and experience to offer each other. Everyone’s breastfeeding journey is completely different. There are going to be different challenges and different triumphs throughout all of it. But talking to your peers and finding out what worked for them or what didn’t work for them could be really helpful in navigating some of those challenges.

Dr. Myra Wick:

In our outpatient area, we have a lactation consultant available, and she’ll see patients or she’ll call patients. She’s awesome. If you’re having trouble after you get back home, she’s there to help, too.

Dr. Angela Mattke:

Yeah, absolutely. Tap into those resources. Don’t sit alone and cry. You probably will sit alone and cry at some point. But don’t do it alone. Talk to people, and get some help. This has been a fabulous discussion. Thank you, Dr. Wick, for joining us again. And I hope you’ll join us for more upcoming episodes in our podcast, including the next episode where we will move onto talking more about the postpartum phase and what to expect in the first six weeks after delivery. We’re going to be including topics such as: is it normal to feel this way after having a baby? We’re going to talk about baby blues, anxiety, postpartum depression, surviving exhaustion–and I promise you, you will survive, and you will look back and have no idea how you made it through. But we’re also going to talk about dealing with those physical changes. Your body is different, and it’s never going to go back to the way it was before. That’s not always bad; things change, our bodies change. We’re going to get into all of those details.

Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode, and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and  a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at Mayo Clinic Children’s Center in Rochester, Minnesota.

Nipunie Rajapakse, M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

Myra J. Wick, M.D., Ph.D.

Dr. Wick, medical editor of Mayo Clinic Guide to a Healthy Pregnancy, 2nd Edition, is a specialist in the Department of Obstetrics and Gynecology and the Department of Clinical Genomics. She is also an associate professor at the Mayo Clinic College of Medicine and Science — and a mother of four children. Dr. Wick has particular medical expertise and interest in prenatal genetics and diagnosis.

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